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FOR OFFICE USE: = ------"'�` "'I Permit No.APPLICATION FOR SAN PERMIT - Complete.in Dup irate •--• ••-- ..--• - •Data Issued,- a 7 - This Permit Expires 1 Year om Date Issued r >! �.. ... ........... -..-...--••• , A lication is hereby made tv the San I aquin Local Health District fo a permit to construct and install the work herein described. This application is made in c$mpliance with County Ordinance No. 549. } - --••--- JOB ADDRESS APL,-_,,1 OID �--'--------��-'-�---Owners Name----- =.. - .. ...._. - ri............................................ Phone .t. I .............................------------------------------�' -------------- ---- Address...............- � -A- - .-- ---.. .---....-...-I---- - - d=- Can#rector's Name----_-_- --'-._._ --__-- ! �a Phone---•_-•- -- ` Other ❑ Comme.ial Trailer Court ❑ Motel ❑ Installation will serve: ;Residence � Apartment House ❑ ❑ s 1-1 ------ -------•-••--•-,-,...... Number of living units. J...__ Number of bedrooms _�_.. Numloe.r of baths --�---- Lot sire ._____ t.r4 ;r Water Supply: Public syste A ❑ Community system ❑%Private 3- Depth to Water Table 00 ft. '•'' Clay Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑es., am❑ Clay Loam❑ y ❑ No Clprevious Application Made: �llf yes,dote.._-..-.... ] No�] New Construction: Yes ED No>. FHA/VA:Yes❑ TYPE OF INSTALLATION 4ND SPECIFICATIONS: (No septic-tank or cesspool permitted if public sewer is-available within 204 feet.] 1 Septic Tank_ Distance 4from nearest well------------------Distance from.foundation_--.-_----__----.._.Material_`____...------" -•--•--------- ----------_. ❑ No. ❑f compartments.__..-._.._....._.....__..5ixe--------------- .�••-- ---Liquid depth..........................Capacity......-._.-_r_+----- 3 t Disposal Field: Disten a,from nearest well._-_jfrom foundation---_L-17 !....Distance to nearest lot line._.��I'L._._______ Number of lines-----_--1........... Length of each-kne_�....-._X-I?l ..........Width of french..__•-••-- "' -------••-• . ..- T e of filter material---�:.:'- �'-. epth of fi4ter: at�rial_-.__...1__ ---....Total len th...---.•-••--�`+ --_--- YP % Seepage Pit: Distance'to nearest r+ell...__ _�-S!-�••--Distance fro faundation___...��-0----Distance to nearest lot line-Z -----• kA Number o4 pits-_---- ---------I fining material_- -'-- {.- size_-•Diameter._-_,3e_ ..Depth........__..------- - - 11 Disfanee°from nearest well---------------=Distance from foundation...:----__,.--•.--•Lining material._...:.........__..._ .......-__-__-- r Cesspool: t Is. . Size: Diameter------- - -------------...............Depth._------� _. � :......................Liquid Capacity --ga Privy: Disfance;from nearest Well--------------------------.,---------- Distance from nearest building-----•----•--••--•--..__._.__--- ------•. i ❑ Distancelo nearest lot-line.................... ---- ..._ - - - ------------- ....... ' •--•--••--•.................... Remodeling and/or repairinq (describe:--.--__a •-- ------ ------------- - - • „------=--•-•--• -----------�...-•---- _-••-••- t._. ••- -• ' Ii...............:.......•------_--_..,...• •--- ...........---••--•• -•• . •- ...............I---------------- --------------•----------- -• 1� .......................-.... ------ •-- �I - r. =-- '- ........_._..._....__.. ... •--••---,--•.--------••---•-•---••------ -..__.._.. s. i hereby certify that have prepared this application and }hat e worVwill be done in accordance with San Joaquin County r Ordinances. State laws, and rules and ieguiations of the San .laaqui Lohal Health District. '- C t 1 (Signed) ---.._..---••--•--.....-.----..-_.._--...-__IOwn and/or ontrac or (Title).......... - ( -------------- Plot plan, showing sae of,.lot-;lata+ion of ayste in`�relation tb walls,! buildings, etc., can be-plat®d on reverse side FOR DEPARTMENT USE ONLY s rt E .............. . APPLICATION ACCEPTED BY--.------._:1-- , _.. DAT ....__ .----- -• -_.-•-•- + � �: i - t - .. TF---•---------------------------------- •--•-••-------------- REVIEWED By------------------- 7 DA ---- --•----------••-......_------------• ----�_.�-------I--- �-- DATE...................-----------------.........,..------------- BUILDING PERMIT ISSUED- -- ------------- - •„.,.....- -----• :.... •f -t - A'-' ti-" .. ------.---__•----------------••-•----••••---..--.--..........,........._.. AlteratroRda o r ecommendatrons:.__:- _... - - .......... - .............. -....... ............................. . '� ,:#.. ....................... ................................... ......................................--• 'F-_. -. -••...............................................s..• -.I. _.._.......... :_......::.- .......... ........................_..._-------------- -�•--•---•...._ • .....,.......-_..---•-•.-,....;�.._.._... ... ... .__.._. _..._......,... _ �. ... ,�..........� .................. FINAL INSPECTION BY.-_.., . neer'_.--- -------------------•;_- �' SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Hn:elton Ave. 304 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Iracy,California Stacktan,Cellfornia r .I ES 9 REVIGE❑ 8.59 ;Jh1.3`r3 F-P.CQ.